April 21, 2026
3 min read
Key takeaways:
- Automated physician alerts improved referral for valvular heart disease intervention.
- Electronic alerts may help reduce disparities in referral for aortic stenosis and mitral regurgitation.
NEW ORLEANS — Automated physician alerts improved the rate of referral for prompt intervention when valvular heart disease was detected on echocardiography, a speaker reported.
Automated alerts via a natural language processing model (Tempus Next, Tempus AI) could improve care of aortic stenosis and mitral regurgitation and reduce disparities in referral rates for repair or replacement, according to the results of the multicenter, cluster-randomized, superiority ALERT clinical trial presented at the American College of Cardiology Scientific Session and simultaneously published in the Journal of the American College of Cardiology.
The ALERT trial and prior data
Wayne B. Batchelor
“Aortic stenosis and mitral regurgitation are common entities that afflict a lot of patients across the world and United States and result in significant morbidity and mortality when untreated. Despite current recommendations, including class I and 2a recommendations for valve therapy, less than 50% received treatment for aortic stenosis within 90 days, and there are significant disparities that run across age, sex, race, rurality and social determinants of health,” Wayne B. Batchelor, MD, MHS, MBA, president of Inova Medicine Service Line, Schar chair of Inova Schar Heart and Vascular, director emeritus of interventional cardiology at Inova and professor of medicine at Duke University School of Medicine, said during a presentation. “Our purpose was to evaluate if automated, electronic clinician notification alerts improve timely multidisciplinary team evaluation and valve intervention in a diverse population of patients with significant aortic stenosis and mitral regurgitation across multiple health systems.”
Prior studies such as the DETECT-AS trial have evaluated the use of electronic clinician notification systems to increase treatment of aortic stenosis.
As Healio previously reported, the DETECT-AS notification system increased rates of valve replacement with 1 year among patients diagnosed with severe aortic stenosis compared with usual care.
Megan Coylewright
“As much as we hope that every patient is treated like family, the data are clear that we don’t refer patients at the same rates. Our hope was that through automated referral, we may be able to impact some of those differences,” Megan Coylewright, MD, MPH, FACC, FSCAI, structural interventional cardiologist at Essentia Health, told Healio.
Automated alerts for valvular heart care
Patients with echocardiographic evidence of aortic stenosis and mitral regurgitation from five U.S. health systems, including 35 hospitals, were enrolled in the ALERT trial between August 2024 and September 2025.
Overall, 765 clinicians were randomly assigned to an automated alert when valvular heart disease was detected via natural language processing of echocardiography reports or to a control group with no alert and remained in their group, masked to treatment allocation for the trial duration, according to the study design. Patients were not notified of the alert.
Patients were excluded if they had undergone prior heart valve intervention, were seen by a multidisciplinary heart team or had a planned valve intervention or evaluation by a multidisciplinary heart team.
The primary endpoint was a hierarchical composite of time to valve intervention and time to multidisciplinary heart team visit within 90 days after index echocardiogram, expressed as a win ratio.
The ALERT study included evaluations of 2,016 echocardiograms.
The researchers reported that the electronic alert was superior to usual care (win ratio, 1.27; 95% CI, 1.05-1.54; P = .007) for both increasing rates of valve intervention (13.4% vs. 9.6%; P = .005) and multidisciplinary heart team evaluation (22.7% vs. 17.9%; P = .005) within 90 days compared with the control group.
Effect sizes were similar for both aortic stenosis and mitral regurgitation, and the results were consistent regardless of valve pathology and prespecified subgroup stratified by age, sex, race, social deprivation index, inpatient vs. outpatient setting, physician specialty and rurality, according to the study.
“We found that receiving the alert did improve the quality of care delivered by improving the number of patients that were evaluated by the heart valve team and then went on to repair and replacement, and we saw a signal that this helped with some of the disparities that we see for referrals for women,” Coylewright told Healio. “Some hospital systems were able to implement this much easier than others and some faced barriers that we had to work through, but we learned a tremendous amount, and there will be substudies that will come from the ALERT trial to help us understand the most effective and most efficient way to implement programs that allow us to identify patients that will benefit from CV therapies.”
For more information:
Megan Coylewright, MD, MPH, FACC, FSCAI, can be reached at cardiology@healio.com.
Sources/Disclosures
Source:
Batchelor WB, et al. Featured clinical research IV. Presented at: American College of Cardiology Scientific Session; March 28-30, 2026; New Orleans (hybrid meeting).
Reference:
Disclosures:
This study was funded by Tempus AI and Medtronic. Batchelor reports serving as a consultant for Abbott, Boston Scientific, Edwards Lifesciences and Medtronic and receiving investigator-initiated grants from Abbott and Boston Scientific. Coylewright reports serving as a consultant for Alleviant, Boston Scientific, Edwards Lifesciences, Medtronic and Recor Medical and receiving investigator-initiated grants from Edwards Lifesciences.
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